|
HCHG URIC ACID BLOOD
|
Facility
|
OP
|
$84.00
|
|
|
Service Code
|
HCPCS 84550
|
| Hospital Charge Code |
H3011262
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.52 |
| Max. Negotiated Rate |
$83.16 |
| Rate for Payer: AlohaCare Medicaid |
$42.00
|
| Rate for Payer: AlohaCare Medicare |
$75.60
|
| Rate for Payer: Cash Price |
$54.60
|
| Rate for Payer: Cash Price |
$54.60
|
| Rate for Payer: Devoted Health Medicare |
$83.16
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$6.25
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$5.65
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$75.60
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$6.56
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4.52
|
| Rate for Payer: Health Management Network Commercial |
$71.40
|
| Rate for Payer: Humana Medicare |
$75.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$75.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$42.84
|
| Rate for Payer: Kaiser Permanente Medicare |
$75.60
|
| Rate for Payer: MDX Hawaii PPO |
$81.48
|
| Rate for Payer: Ohana Health Plan Medicaid |
$75.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$75.60
|
| Rate for Payer: UnitedHealthcare Medicaid |
$6.25
|
| Rate for Payer: UnitedHealthcare Medicare |
$75.60
|
| Rate for Payer: University Health Alliance Commercial |
$11.67
|
|
|
HCHG URIC ACID BLOOD
|
Facility
|
IP
|
$84.00
|
|
|
Service Code
|
HCPCS 84550
|
| Hospital Charge Code |
H3011262
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$71.40 |
| Max. Negotiated Rate |
$81.48 |
| Rate for Payer: Cash Price |
$54.60
|
| Rate for Payer: Health Management Network Commercial |
$71.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$75.60
|
| Rate for Payer: MDX Hawaii PPO |
$81.48
|
|
|
HCHG URIC ACID BODY FLUID
|
Facility
|
OP
|
$39.00
|
|
|
Service Code
|
HCPCS 84560
|
| Hospital Charge Code |
H3011266
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.08 |
| Max. Negotiated Rate |
$38.61 |
| Rate for Payer: AlohaCare Medicaid |
$19.50
|
| Rate for Payer: AlohaCare Medicare |
$35.10
|
| Rate for Payer: Cash Price |
$25.35
|
| Rate for Payer: Cash Price |
$25.35
|
| Rate for Payer: Devoted Health Medicare |
$38.61
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$6.56
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$6.35
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$35.10
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$6.89
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5.08
|
| Rate for Payer: Health Management Network Commercial |
$33.15
|
| Rate for Payer: Humana Medicare |
$35.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$35.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$19.89
|
| Rate for Payer: Kaiser Permanente Medicare |
$35.10
|
| Rate for Payer: MDX Hawaii PPO |
$37.83
|
| Rate for Payer: Ohana Health Plan Medicaid |
$35.10
|
| Rate for Payer: Ohana Health Plan Medicare |
$35.10
|
| Rate for Payer: UnitedHealthcare Medicaid |
$6.56
|
| Rate for Payer: UnitedHealthcare Medicare |
$35.10
|
| Rate for Payer: University Health Alliance Commercial |
$12.28
|
|
|
HCHG URIC ACID BODY FLUID
|
Facility
|
IP
|
$39.00
|
|
|
Service Code
|
HCPCS 84560
|
| Hospital Charge Code |
H3011266
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.15 |
| Max. Negotiated Rate |
$37.83 |
| Rate for Payer: Cash Price |
$25.35
|
| Rate for Payer: Health Management Network Commercial |
$33.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$35.10
|
| Rate for Payer: MDX Hawaii PPO |
$37.83
|
|
|
HCHG URIC ACID URINE
|
Facility
|
OP
|
$39.00
|
|
|
Service Code
|
HCPCS 84560
|
| Hospital Charge Code |
H3011268
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.08 |
| Max. Negotiated Rate |
$38.61 |
| Rate for Payer: AlohaCare Medicaid |
$19.50
|
| Rate for Payer: AlohaCare Medicare |
$35.10
|
| Rate for Payer: Cash Price |
$25.35
|
| Rate for Payer: Cash Price |
$25.35
|
| Rate for Payer: Devoted Health Medicare |
$38.61
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$6.56
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$6.35
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$35.10
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$6.89
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5.08
|
| Rate for Payer: Health Management Network Commercial |
$33.15
|
| Rate for Payer: Humana Medicare |
$35.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$35.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$19.89
|
| Rate for Payer: Kaiser Permanente Medicare |
$35.10
|
| Rate for Payer: MDX Hawaii PPO |
$37.83
|
| Rate for Payer: Ohana Health Plan Medicaid |
$35.10
|
| Rate for Payer: Ohana Health Plan Medicare |
$35.10
|
| Rate for Payer: UnitedHealthcare Medicaid |
$6.56
|
| Rate for Payer: UnitedHealthcare Medicare |
$35.10
|
| Rate for Payer: University Health Alliance Commercial |
$12.28
|
|
|
HCHG URIC ACID URINE
|
Facility
|
IP
|
$39.00
|
|
|
Service Code
|
HCPCS 84560
|
| Hospital Charge Code |
H3011268
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.15 |
| Max. Negotiated Rate |
$37.83 |
| Rate for Payer: Cash Price |
$25.35
|
| Rate for Payer: Health Management Network Commercial |
$33.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$35.10
|
| Rate for Payer: MDX Hawaii PPO |
$37.83
|
|
|
HCHG URINALYSIS MICRO ONLY
|
Facility
|
OP
|
$46.00
|
|
|
Service Code
|
HCPCS 81015
|
| Hospital Charge Code |
H3070114
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$3.05 |
| Max. Negotiated Rate |
$45.54 |
| Rate for Payer: AlohaCare Medicaid |
$23.00
|
| Rate for Payer: AlohaCare Medicare |
$41.40
|
| Rate for Payer: Cash Price |
$29.90
|
| Rate for Payer: Cash Price |
$29.90
|
| Rate for Payer: Devoted Health Medicare |
$45.54
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$4.20
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$3.81
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$41.40
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$4.41
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3.05
|
| Rate for Payer: Health Management Network Commercial |
$39.10
|
| Rate for Payer: Humana Medicare |
$41.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$41.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$23.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$41.40
|
| Rate for Payer: MDX Hawaii PPO |
$44.62
|
| Rate for Payer: Ohana Health Plan Medicaid |
$41.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$41.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4.20
|
| Rate for Payer: UnitedHealthcare Medicare |
$41.40
|
| Rate for Payer: University Health Alliance Commercial |
$7.84
|
|
|
HCHG URINALYSIS MICRO ONLY
|
Facility
|
IP
|
$46.00
|
|
|
Service Code
|
HCPCS 81015
|
| Hospital Charge Code |
H3070114
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$39.10 |
| Max. Negotiated Rate |
$44.62 |
| Rate for Payer: Cash Price |
$29.90
|
| Rate for Payer: Health Management Network Commercial |
$39.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$41.40
|
| Rate for Payer: MDX Hawaii PPO |
$44.62
|
|
|
HCHG URINALYSIS, REFLEX MICROSCOPIC
|
Facility
|
IP
|
$42.00
|
|
|
Service Code
|
HCPCS 81003
|
| Hospital Charge Code |
H3070135
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$35.70 |
| Max. Negotiated Rate |
$40.74 |
| Rate for Payer: Cash Price |
$27.30
|
| Rate for Payer: Health Management Network Commercial |
$35.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$37.80
|
| Rate for Payer: MDX Hawaii PPO |
$40.74
|
|
|
HCHG URINALYSIS, REFLEX MICROSCOPIC
|
Facility
|
OP
|
$42.00
|
|
|
Service Code
|
HCPCS 81003
|
| Hospital Charge Code |
H3070135
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$2.25 |
| Max. Negotiated Rate |
$41.58 |
| Rate for Payer: AlohaCare Medicaid |
$21.00
|
| Rate for Payer: AlohaCare Medicare |
$37.80
|
| Rate for Payer: Cash Price |
$27.30
|
| Rate for Payer: Cash Price |
$27.30
|
| Rate for Payer: Devoted Health Medicare |
$41.58
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$3.10
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$2.81
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$37.80
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$3.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2.25
|
| Rate for Payer: Health Management Network Commercial |
$35.70
|
| Rate for Payer: Humana Medicare |
$37.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$37.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$21.42
|
| Rate for Payer: Kaiser Permanente Medicare |
$37.80
|
| Rate for Payer: MDX Hawaii PPO |
$40.74
|
| Rate for Payer: Ohana Health Plan Medicaid |
$37.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$37.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$3.10
|
| Rate for Payer: UnitedHealthcare Medicare |
$37.80
|
| Rate for Payer: University Health Alliance Commercial |
$5.81
|
|
|
HCHG URINE DRUG SCREEN, POC
|
Facility
|
IP
|
$129.00
|
|
|
Service Code
|
HCPCS 80305
|
| Hospital Charge Code |
H3011825
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$109.65 |
| Max. Negotiated Rate |
$125.13 |
| Rate for Payer: Cash Price |
$83.85
|
| Rate for Payer: Health Management Network Commercial |
$109.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$116.10
|
| Rate for Payer: MDX Hawaii PPO |
$125.13
|
|
|
HCHG URINE DRUG SCREEN, POC
|
Facility
|
OP
|
$129.00
|
|
|
Service Code
|
HCPCS 80305
|
| Hospital Charge Code |
H3011825
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.98 |
| Max. Negotiated Rate |
$127.71 |
| Rate for Payer: AlohaCare Medicaid |
$64.50
|
| Rate for Payer: AlohaCare Medicare |
$116.10
|
| Rate for Payer: Cash Price |
$83.85
|
| Rate for Payer: Cash Price |
$83.85
|
| Rate for Payer: Devoted Health Medicare |
$127.71
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$19.03
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$15.75
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$116.10
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$21.11
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12.60
|
| Rate for Payer: Health Management Network Commercial |
$109.65
|
| Rate for Payer: Humana Medicare |
$116.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$116.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$65.79
|
| Rate for Payer: Kaiser Permanente Medicare |
$116.10
|
| Rate for Payer: MDX Hawaii PPO |
$125.13
|
| Rate for Payer: Ohana Health Plan Medicaid |
$116.10
|
| Rate for Payer: Ohana Health Plan Medicare |
$116.10
|
| Rate for Payer: UnitedHealthcare Medicaid |
$8.98
|
| Rate for Payer: UnitedHealthcare Medicare |
$116.10
|
| Rate for Payer: University Health Alliance Commercial |
$27.68
|
|
|
HCHG URINE PREGNANCY TEST, VISUAL COLOR COMP
|
Facility
|
IP
|
$63.00
|
|
|
Service Code
|
HCPCS 81025
|
| Hospital Charge Code |
H3011270
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$53.55 |
| Max. Negotiated Rate |
$61.11 |
| Rate for Payer: Cash Price |
$40.95
|
| Rate for Payer: Health Management Network Commercial |
$53.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$56.70
|
| Rate for Payer: MDX Hawaii PPO |
$61.11
|
|
|
HCHG URINE PREGNANCY TEST, VISUAL COLOR COMP
|
Facility
|
OP
|
$63.00
|
|
|
Service Code
|
HCPCS 81025
|
| Hospital Charge Code |
H3011270
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$8.61 |
| Max. Negotiated Rate |
$62.37 |
| Rate for Payer: AlohaCare Medicaid |
$31.50
|
| Rate for Payer: AlohaCare Medicare |
$56.70
|
| Rate for Payer: Cash Price |
$40.95
|
| Rate for Payer: Cash Price |
$40.95
|
| Rate for Payer: Devoted Health Medicare |
$62.37
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$8.74
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$10.76
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$56.70
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$9.18
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$8.61
|
| Rate for Payer: Health Management Network Commercial |
$53.55
|
| Rate for Payer: Humana Medicare |
$56.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$56.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$32.13
|
| Rate for Payer: Kaiser Permanente Medicare |
$56.70
|
| Rate for Payer: MDX Hawaii PPO |
$61.11
|
| Rate for Payer: Ohana Health Plan Medicaid |
$56.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$56.70
|
| Rate for Payer: UnitedHealthcare Medicaid |
$8.74
|
| Rate for Payer: UnitedHealthcare Medicare |
$56.70
|
| Rate for Payer: University Health Alliance Commercial |
$16.35
|
|
|
HCHG URNLS DIP STICK/TABLET RGNT NON-AUTO W/O MICRSCP
|
Facility
|
IP
|
$47.00
|
|
|
Service Code
|
HCPCS 81002
|
| Hospital Charge Code |
H3070136
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$39.95 |
| Max. Negotiated Rate |
$45.59 |
| Rate for Payer: Cash Price |
$30.55
|
| Rate for Payer: Health Management Network Commercial |
$39.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$42.30
|
| Rate for Payer: MDX Hawaii PPO |
$45.59
|
|
|
HCHG URNLS DIP STICK/TABLET RGNT NON-AUTO W/O MICRSCP
|
Facility
|
OP
|
$47.00
|
|
|
Service Code
|
HCPCS 81002
|
| Hospital Charge Code |
H3070136
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$3.48 |
| Max. Negotiated Rate |
$46.53 |
| Rate for Payer: AlohaCare Medicaid |
$23.50
|
| Rate for Payer: AlohaCare Medicare |
$42.30
|
| Rate for Payer: Cash Price |
$30.55
|
| Rate for Payer: Cash Price |
$30.55
|
| Rate for Payer: Devoted Health Medicare |
$46.53
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$3.54
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$4.35
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$42.30
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$3.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3.48
|
| Rate for Payer: Health Management Network Commercial |
$39.95
|
| Rate for Payer: Humana Medicare |
$42.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$42.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$23.97
|
| Rate for Payer: Kaiser Permanente Medicare |
$42.30
|
| Rate for Payer: MDX Hawaii PPO |
$45.59
|
| Rate for Payer: Ohana Health Plan Medicaid |
$42.30
|
| Rate for Payer: Ohana Health Plan Medicare |
$42.30
|
| Rate for Payer: UnitedHealthcare Medicaid |
$3.54
|
| Rate for Payer: UnitedHealthcare Medicare |
$42.30
|
| Rate for Payer: University Health Alliance Commercial |
$6.60
|
|
|
HCHG U/S GUIDE INTRAOP
|
Facility
|
IP
|
$290.00
|
|
|
Service Code
|
HCPCS 76998
|
| Hospital Charge Code |
H4020170
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$246.50 |
| Max. Negotiated Rate |
$281.30 |
| Rate for Payer: Cash Price |
$188.50
|
| Rate for Payer: Health Management Network Commercial |
$246.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$261.00
|
| Rate for Payer: MDX Hawaii PPO |
$281.30
|
|
|
HCHG U/S GUIDE INTRAOP
|
Facility
|
OP
|
$290.00
|
|
|
Service Code
|
HCPCS 76998
|
| Hospital Charge Code |
H4020170
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$93.99 |
| Max. Negotiated Rate |
$287.10 |
| Rate for Payer: AlohaCare Medicaid |
$145.00
|
| Rate for Payer: AlohaCare Medicare |
$261.00
|
| Rate for Payer: Cash Price |
$188.50
|
| Rate for Payer: Cash Price |
$188.50
|
| Rate for Payer: Devoted Health Medicare |
$287.10
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$261.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$93.99
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$275.50
|
| Rate for Payer: Health Management Network Commercial |
$246.50
|
| Rate for Payer: Humana Medicare |
$261.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$261.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$147.90
|
| Rate for Payer: Kaiser Permanente Medicare |
$261.00
|
| Rate for Payer: MDX Hawaii PPO |
$281.30
|
| Rate for Payer: Ohana Health Plan Medicaid |
$261.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$261.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$261.00
|
| Rate for Payer: University Health Alliance Commercial |
$211.38
|
|
|
HCHG U/S PELVIS COMP PORT
|
Facility
|
IP
|
$758.00
|
|
|
Service Code
|
HCPCS 76856
|
| Hospital Charge Code |
H4020232
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$644.30 |
| Max. Negotiated Rate |
$735.26 |
| Rate for Payer: Cash Price |
$492.70
|
| Rate for Payer: Health Management Network Commercial |
$644.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$682.20
|
| Rate for Payer: MDX Hawaii PPO |
$735.26
|
|
|
HCHG U/S PELVIS COMP PORT
|
Facility
|
OP
|
$758.00
|
|
|
Service Code
|
HCPCS 76856
|
| Hospital Charge Code |
H4020232
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$50.35 |
| Max. Negotiated Rate |
$750.42 |
| Rate for Payer: AlohaCare Medicaid |
$379.00
|
| Rate for Payer: AlohaCare Medicare |
$682.20
|
| Rate for Payer: Cash Price |
$492.70
|
| Rate for Payer: Cash Price |
$492.70
|
| Rate for Payer: Devoted Health Medicare |
$750.42
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$50.35
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$133.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$682.20
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$54.65
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$106.81
|
| Rate for Payer: Health Management Network Commercial |
$644.30
|
| Rate for Payer: Humana Medicare |
$682.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$682.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$386.58
|
| Rate for Payer: Kaiser Permanente Medicare |
$682.20
|
| Rate for Payer: MDX Hawaii PPO |
$735.26
|
| Rate for Payer: Ohana Health Plan Medicaid |
$682.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$682.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$50.35
|
| Rate for Payer: UnitedHealthcare Medicare |
$682.20
|
| Rate for Payer: University Health Alliance Commercial |
$231.53
|
|
|
HCHG US URINE CAPACITY MEASURE
|
Facility
|
OP
|
$428.00
|
|
|
Service Code
|
HCPCS 51798
|
| Hospital Charge Code |
H4500887
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$214.00 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: AlohaCare Medicaid |
$214.00
|
| Rate for Payer: AlohaCare Medicare |
$385.20
|
| Rate for Payer: Cash Price |
$278.20
|
| Rate for Payer: Cash Price |
$278.20
|
| Rate for Payer: Devoted Health Medicare |
$423.72
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$469.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1,600.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$385.20
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$450.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$406.60
|
| Rate for Payer: Health Management Network Commercial |
$363.80
|
| Rate for Payer: Humana Medicare |
$385.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$385.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$385.20
|
| Rate for Payer: MDX Hawaii PPO |
$415.16
|
| Rate for Payer: Ohana Health Plan Medicaid |
$385.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$385.20
|
| Rate for Payer: UnitedHealthcare Medicare |
$385.20
|
| Rate for Payer: University Health Alliance Commercial |
$311.97
|
|
|
HCHG US URINE CAPACITY MEASURE
|
Facility
|
IP
|
$428.00
|
|
|
Service Code
|
HCPCS 51798
|
| Hospital Charge Code |
H4500887
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$363.80 |
| Max. Negotiated Rate |
$415.16 |
| Rate for Payer: Cash Price |
$278.20
|
| Rate for Payer: Health Management Network Commercial |
$363.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$385.20
|
| Rate for Payer: MDX Hawaii PPO |
$415.16
|
|
|
HCHG VALPROIC ACID
|
Facility
|
IP
|
$202.00
|
|
|
Service Code
|
HCPCS 80164
|
| Hospital Charge Code |
H3011272
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$171.70 |
| Max. Negotiated Rate |
$195.94 |
| Rate for Payer: Cash Price |
$131.30
|
| Rate for Payer: Health Management Network Commercial |
$171.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$181.80
|
| Rate for Payer: MDX Hawaii PPO |
$195.94
|
|
|
HCHG VALPROIC ACID
|
Facility
|
OP
|
$202.00
|
|
|
Service Code
|
HCPCS 80164
|
| Hospital Charge Code |
H3011272
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.54 |
| Max. Negotiated Rate |
$199.98 |
| Rate for Payer: AlohaCare Medicaid |
$101.00
|
| Rate for Payer: AlohaCare Medicare |
$181.80
|
| Rate for Payer: Cash Price |
$131.30
|
| Rate for Payer: Cash Price |
$131.30
|
| Rate for Payer: Devoted Health Medicare |
$199.98
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$18.72
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$16.93
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$181.80
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$19.66
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$13.54
|
| Rate for Payer: Health Management Network Commercial |
$171.70
|
| Rate for Payer: Humana Medicare |
$181.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$181.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$103.02
|
| Rate for Payer: Kaiser Permanente Medicare |
$181.80
|
| Rate for Payer: MDX Hawaii PPO |
$195.94
|
| Rate for Payer: Ohana Health Plan Medicaid |
$181.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$181.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$18.72
|
| Rate for Payer: UnitedHealthcare Medicare |
$181.80
|
| Rate for Payer: University Health Alliance Commercial |
$35.02
|
|
|
HCHG VANCOMYCIN LEVEL
|
Facility
|
IP
|
$202.00
|
|
|
Service Code
|
HCPCS 80202
|
| Hospital Charge Code |
H3011274
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$171.70 |
| Max. Negotiated Rate |
$195.94 |
| Rate for Payer: Cash Price |
$131.30
|
| Rate for Payer: Health Management Network Commercial |
$171.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$181.80
|
| Rate for Payer: MDX Hawaii PPO |
$195.94
|
|
